Special care for that special smile

More dentists trained in special care dentistry are needed to meet rising demand to care for patients with special needs, the elderly and patients with complex medical conditions.

The first time Kiran Raj visited a dentist was when he was 21 years old. When he arrived at the National Dental Centre Singapore (NDCS) with his mother, they were both very scared.

“Kiran has epilepsy and is intellectually disabled, so I didn’t dare bring him to the dentist before because I was worried he wouldn’t cooperate and I didn’t know how the dentist would react to his challenging behaviour,” shares Kiran’s mother, Mdm Jothi Marimuthu.

But their first experience at the Geriatric Special Care Dentistry Clinic (GSDC) in 2015 was a pleasant surprise.

“Everyone was kind, patient and accepted him, even though he refused to cooperate. He kept getting out of the chair, so the dentist and nurse spent time chatting to him to calm him down, played his favourite music and introduced him to the dental equipment,” remembers Mdm Jothi.

Kiran attended regular appointments to familiarise him with the routine and the consultation room. At first, he refused to open his mouth so the dentist could only check a few teeth at a time. But she also taught Mdm Jothi how to massage Kiran’s mouth and advised her to use an electric toothbrush to improve his oral care at home.

It took more than one year of monthly appointments before Kiran felt comfortable enough for the dentist to fully examine and clean his teeth. Now, his face lights up when his mother talks about his dental visits.

“He is so at ease now, he can sit in the chair for his 30 to 40-minute consultation and I can wait for him in the reception area. This would not have been possible without this specialty clinic,” says Mdm Jothi. “His teeth look much cleaner and he only needs to go for check-ups once every four months.”

The GSDC opened in late 2015 to provide multidisciplinary dental care to patients with complex medical needs, geriatric conditions and intellectual and physical disabilities. Between January 2017 and April 2018, special needs patients like Kiran made up about 10 per cent of the work load, with the majority of patients being seen for dental clearance before heart surgery and radiotherapy to reduce the risk of infection and complications. Geriatric patients with multiple health conditions accounted for the remaining 20 per cent of GSDC attendances.

“Elderly patients who have had a stroke and suffer from dementia are at risk of tooth decay because they often have poor manual dexterity, forget to brush their teeth or need to rely on a caregiver for their oral care,” says Dr Kong Rui Ling, who treated Kiran. “Often, our only option is to extract severely decayed teeth but these patients are usually on blood thinning medication, so complications with clotting can occur after an extraction.”

Clinic attendances at GSDC almost doubled from 4,000 in 2016 to 7,500 in 2017, and are set to increase further. Singapore’s population is ageing rapidly – by 2030, one in four Singaporeans will be over the age of 65 years and demand for such services will soar.

There is a pressing need to train more dentists in special care dentistry to cater to this niche but growing group of patients. In order to provide the specialised care needed, dentists must complete a three-year postgraduate Master’s programme in an overseas university as local programmes are currently not available. To enable more dentists to pursue special care dentistry training, NDCS hopes to raise about $750,000 to establish scholarships that will build a pipeline of oral healthcare providers in this sub-specialty. Currently, NDCS has only three dentists who have completed or are undergoing training to provide a high level of specialised care.

Dr Kong worked at the GSDC when she joined NDCS as a supervised dental officer in November 2015. She is now a first year resident specialising in prosthodontics, and once qualified, she plans to sub-specialise in geriatric and special needs dentistry. Growing up with her grandmother, Dr Kong has always had a special place in her heart for the elderly. As a child, she also accompanied her mother when she volunteered at the leprosy home and helped people with special needs.

“This is not a glamorous field of dentistry but there is a real need and it’s one where I feel I can make a difference and improve the quality of patients’ lives,” says Dr Kong.

To make a gift or for more information about the scholarship fund, please contact Ms Caroline Chia, Institution Development Officer, NDCS, at: caroline.chia.l.i@ndcs.com.sg tel: 6324 3988 or visit: www.giving.sg/national-dental-centre-singapore.